Abstract

Ferketich et al. studied demographic factors associated with the passage of clean indoor air ordinances in Appalachian communities.1 Based on reported lack of progress at the local level despite strong public support for clean indoor air laws, they recommended that efforts be focused on the state level instead. This conclusion goes beyond the data that they present and does not consider the power of the tobacco industry in state-level politics.2–6 Additionally, recent experience in South Carolina,7 a state Ferketich et al. included in their research, shows that strong progress on local clean indoor air ordinances is possible even in an Appalachian, tobacco-growing state. South Carolina's weak state clean indoor air ordinances passed in 1996 with an assumed preemption clause pushed by cigarette manufacturer lobbyists and hospitality industry allies that halted clean indoor ordinance progress for a decade. However, between May 2006 and January 2008, local advocates, supported by national tobacco control technical assistance and funding, challenged this presumed preemption by passing clean indoor air ordinances in 12 localities, two of which were sued under claims that state preemption did not allow local clean air ordinances. In March 2008, the state Supreme Court ruled that local clean indoor air ordinances were not preempted; since then, advocates have passed 21 more local clean indoor air ordinances. The passage of these local clean indoor air ordinances as of May 2010 has been recognized as the highest number of strong local ordinances passed in any US state for two years in a row.8 Cigarette manufacturing interests responded with an effort to pass explicit state preemption. During the 2007 and 2008 legislative session, 11 neutral to strong clean indoor air bills were introduced; three were co-opted to include weak clean indoor air provisions and preemptive language as a result of tobacco manufacturer lobbying. Tobacco control advocates stopped all weak bills with preemption and convinced legislators to delay state laws, which could become vehicles for preemption.7 The trajectory of South Carolina clean indoor air ordinance progress provides a strong counterpoint to Ferketich et al.'s conclusion that there is a lack of motivation among tobacco control advocates at the local level in tobacco-growing states and that clean indoor air ordinance efforts should focus at the state level. Developing clean indoor air laws at the state level without strong local support provides an opportunity for cigarette manufacturers to preempt more comprehensive local activity, where tobacco manufacturers have less sway.3,9 In contrast, developing the capacity of local advocates can result in a strong smoke-free movement through local smoke-free ordinance adoption.

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